Proper technique for inner cannula change on ventilated patient

[alwaysalearner]

Hi, there. I work in an ICU setting, but I'm relatively new. I've watched a few different people change disposable inner cannulas on patients who are dependent on the ventilator, and everyone does things differently. I am reaching out in search of best practice, and I haven't been able to find a good video or article on it. I've found several on non-ventilated patients, but I specifically am looking for info on ventilated patients. I'd also be interested in learning what you have experienced or how you perform the inner cannula change in your setting.

Thank you!

[LovingLife123]

Your RTs don't do it?

[Kitiger, RN]

Tell the patient what you will be doing. Wash your hands & put on gloves as appropriate. Suction the trach first, then let them breathe on the vent for a couple of minutes.

Be sure the vent circuit is not pulling on the vent at all. Loosen the connection where the vent circuit connects to the old inner cannula. Release the little clamps that hold the inner cannula in place, but don't take the inner cannula all the way out yet (stabilize it with your non-dominant hand.) Pick up the new inner cannula in your dominant hand, use your non-dominant hand to remove the old cannula. Leave the old cannula attached to the vent circuit.

Quickly insert the new cannula, secure it, pop the old inner cannula off the vent circuit and attach the vent circuit to the new cannula. If the person is unstable, you might want to just hold the new cannula in place while you attach the vent, and then secure the cannula.

You will often need to suction the trach again after the cannula is changed.

[applewhitern, BSN, RN]

Your RTs don't do it?

That is a nursing function everywhere I've worked.

[sallyrnrrt, ADN, RN]

I concur with Kitger

As being an RN and RRT.......? What is your hospital policy and procedure policy?

[K+MgSO4, BSN]

As being an RN and RRT.......? What is your hospital policy and procedure policy?

Love this!

[alwaysalearner]

Occasionally, but the expectation is that we work as a team and share responsibility. The same goes for skin assessments; RT does a skin assessment and documents just as often as we do as RNs. So yes, RTs do it, but we also do it.

[alwaysalearner]

@ Kitiger This is exactly what I was looking for. Thank you.

[alwaysalearner]

Tell the patient what you will be doing. Wash your hands & put on gloves as appropriate. Suction the trach first, then let them breathe on the vent for a couple of minutes.

Be sure the vent circuit is not pulling on the vent at all. Loosen the connection where the vent circuit connects to the old inner cannula. Release the little clamps that hold the inner cannula in place, but don't take the inner cannula all the way out yet (stabilize it with your non-dominant hand.) Pick up the new inner cannula in your dominant hand, use your non-dominant hand to remove the old cannula. Leave the old cannula attached to the vent circuit.

Quickly insert the new cannula, secure it, pop the old inner cannula off the vent circuit and attach the vent circuit to the new cannula. If the person is unstable, you might want to just hold the new cannula in place while you attach the vent, and then secure the cannula.

You will often need to suction the trach again after the cannula is changed.

This is exactly what I was looking for. Thank you.